Volar locking plate

Volar locking plates or distal volar radial anatomical plates are the most commonly used metallic device in the open reduction and internal stabilization of distal radius fractures. These devices allow immediate postoperative return of motion, and are good at preventing angular displacement. Their careful positioning is however key to prevent iatrogenic injuries during surgery, or chronic sequelae such as late onset tenosynovitis.

Practical points

Volar locking plate implantations can have multiple early and late complications, many of which can be picked up on plain film, highlighting the importance of their careful assessment. Screws penetrating the dorsal cortex of the radius may damage extensor tendons, whilst the flexor compartment can be injured during volar plate positioning. The distal, angled screws or pegs can enter the distal radioulnar joint. Volar overprominence of the plate may also result in flexor tenosynovitis and poor outcome .

In comparison with conventional external fixation, volar locking plate treatment of unstable intra-articular wrist fractures proved to be superior in terms of postoperative wrist mobility, articular congruence, and correction of ulnar variance. However it displayed similar functional outcomes and complication rates .